The NPDB - Data Analysis Tool (2023)

The following vocabulary and terminology are associated with the National Practitioner Data Bank (NPDB) and apply to the NPDB, its policies, and procedures.

Adverse Action Report (AAR) - the report format used to submit actions, other than medical malpractice payments and convictions and judgments, taken against a health care practitioner, entity, provider, or supplier. AARs in this Data Analysis Tool reflect actions against health care practitioners only.

Adversely affects - reduces, restricts, suspends, revokes, or denies clinical privileges or membership in a health care entity.

Authorized agent - an individual or organization that an eligible entity designates to query the NPDB on its behalf. In most cases, an authorized agent is an independent contractor to the requesting entity (for instance, a county medical society or state hospital association) used for centralized credentialing. An authorized agent cannot query the NPDB without designation from an eligible entity.

Authorized submitter - an individual empowered by an eligible entity to submit reports or queries to the NPDB. The authorized submitter certifies the legitimacy of information in a query or report submitted to the NPDB. In most cases, the authorized submitter is an employee of the eligible entity (such as an Administrator or Medical Staff Director).

Board of Medical Examiners - a body or subdivision of such body that is designated by a State for licensing, monitoring, and disciplining physicians or dentists. This term includes boards of allopathic or osteopathic examiners, a composite board, a subdivision, or an equivalent body as determined by the State.

Clinical privileges - privileges, membership on the medical staff, and other circumstances (including panel memberships) in which a physician, dentist, or other licensed health care practitioner is permitted to furnish medical care by a health care entity.

Dentist - a doctor of dental surgery, a doctor of dental medicine, or the equivalent who is legally authorized to practice dentistry by a State, or who, without authority, holds himself or herself out to be so authorized (includes residents).

Department of Health and Human Services (DHHS) - the Federal Government agency responsible for administering the NPDB.

(Video) NPDB Reporting Clinical Privileges Webcast

Drug Enforcement Administration (DEA) - the Federal Government agency that registers practitioners to dispense controlled substances and assigns practitioners Federal DEA Numbers.

Formal peer review process - the conduct of professional review activities through formally adopted written procedures that provide for adequate notice and an opportunity for a hearing.

Freedom of Information Act (FOIA) - the law that provides public access to Federal Governmental records.

Health Care Practitioner, Licensed Health Care Practitioner, Licensed Practitioner, or Practitioner - defined in NPDB regulations as “an individual who is licensed or otherwise authorized by a state to provide health care services (or any individual who, without authority, holds himself or herself out to be so licensed or authorized).”

Health Care Quality Improvement Act of 1986, as amended - Title IV of Public Law 99-660; legislation intended to improve the quality of medical care by encouraging hospitals, State Licensing Boards, and other health care entities, including professional societies, to identify and discipline those who engage in unprofessional behavior; and to restrict the ability of incompetent practitioners to move from State to State without disclosure or discovery of the practitioners' previous damaging or incompetent performance.

Health care entity - (1) a hospital; (2) an entity that provides health care services and follows a formal peer review process for the purpose of furthering quality health care; or (3) a professional society or a committee or agent thereof, including those at the national, State, or local level, of physicians, dentists, or other health care practitioners, that follows a formal peer review process for the purpose of furthering quality health care.

Hospital [as described in Section 1861(e)(1) and (7) of the Social Security Act] - an institution primarily engaged in providing, by or under the supervision of physicians, to inpatients (1) diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons; or (2) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, and, if required by State or local law, is licensed or is approved by the agency of the State or locality responsible for licensing hospitals as meeting the standards established for such licensing.

Inflation Adjusted - the inflation adjustment uses the Bureau of Labor Statistics June 2017 seasonally adjusted (SA) CPI-U, US City Average, All Items. For 1990, we use the September figure. For all other years , we use the June figure to compute the inflation factor that is applied to each payment range.

Medical malpractice payer - an entity that makes a medical malpractice payment through an insurance policy or otherwise for the benefit of a practitioner.

(Video) All About the National Practitioner Data Bank & Regulatory Affairs by Health Care Lawyer

Medical malpractice payment - a monetary exchange as a result of a settlement or judgment of a written complaint or claim demanding payment based on a physician's, dentist's, or other licensed health care practitioner's provision of or failure to provide health care services, and may include, but is not limited to, the filing of a cause of action, based on the law of tort, brought in any State or Federal Court or other adjudicative body.

Medical Malpractice Payment Report - the format used by medical malpractice payers to report a medical malpractice payment made for the benefit of a physician, dentist, or other health care practitioner.

Occupation/Field of Licensure Codes - a list of occupational activities/licensure categories for health care practitioners, providers, and suppliers, and the codes used to identify them.

Physician - a doctor of medicine or osteopathy who is legally authorized to practice medicine or surgery by a State, or who, without authority, holds himself or herself out to be so authorized (includes residents and interns).

Other Territories - includes American Samoa, Marshall Islands, Virgin Islands, Northern Mariana Islands, Palau, Federated States of Micronesia and Guam. Data for Puerto Rico is listed separately.

Practitioner Type - grouping used to classify practitioners into a fixed number of nominal groups to facilitate analysis. The practitioner grouping for each type along with the associated NPDB Public Use File licensure codes are summarized in the following table:

Practitioner Type Code Label
Physician (MD)010Physician (MD)
015Physician Intern/Resident (MD)
Physician (DO)020Osteopathic Physician (DO)
025Osteopathic Physician Intern/Resident (DO)
Chiropractor603Chiropractor
604Chiropractic Assistant
605Other Chiropractic Occupation - Not Classified
Dental Hygienist/Assistant606Dental Assistant
607Dental Therapist/Dental Health Aide
609Dental Hygienist
612Denturist
613Other Dental Occupation, Not Classified

Dentist

030Dentist
035Dental Resident
Nurse - Advanced Practice Nurse110Nurse Anesthetist
120Nurse Midwife
130Nurse Practitioner
134(Retired Code) Doctor of Nursing Practice
135(Retired Code) Advance Practice Nurse
141Clinical Nurse Specialist
Nurse - Registered Nurse100Registered (Professional) Nurse
Nurse - Practical Nurse140Licensed Practical or Vocational Nurse
142Other Nurse Occupation - Not Classified
Nursing Para-Professionals148Certified Nurse Aide/Certified Nursing Assistant
150Nurses Aide
160Home Health Aide (Homemaker)
165Health Care Aide/Direct Care Worker
175Certified or Qualified Medication Aide
176Other Aide Occupation - Not Classified
Optometrist630Ocularist
633Optician
636Optometrist
637Other Eye and Vision Service Occupation - Not Classified
Pharmacist050Pharmacist
055Pharmacy Intern
060Pharmacist Nuclear
076Other Pharmacy Service Occupation - Not Classified
Physician Assistant642Physician Assistant (MD)
645Physician Assistant (DO)
Podiatrist350Podiatrist
649Other Podiatric Service Occupation - Not Classified
Psychologist370(Retired Code) Clinical Psychologist
371Psychologist
372School Psychologist
374Other Psychologist/Psychological Assistant Occupation - Not Classified
Social Worker300Clinical Social Worker
Technicians and Assistants070Pharmacy Assistant
075Pharmacy Technician
170Psychiatric Technician
240Emergency Medical Responder
250EMT, Basic
260EMT, Cardiac/Critical Care
270EMT, Intermediate
280EMT, Paramedic
281Other Emergency Medical Technician Occupation - Not Classified
373Psychological Assistant, Associate, Examiner
420Occupational Therapy Assistant
440Physical Therapy Assistant
470Hearing Aid Specialist, Dealer, Dispenser, or Filter
471Other Speech, Language, and Hearing Service Occupation - Not Classified
500(Retired Code) Medical Technologist
501Medical or Clinical Laboratory Technologist
502Medical or Clinical Laboratory Technician
503Surgical Technologist
504Surgical Assistant
505Cytotechnologist
510Nuclear Medicine Technologist
520Radiation Therapy Technologist
530Radiologic Technologist
540X-Ray Technician or Operator
550Limited X-Ray Machine Operator
551Other Technologist/Technician - Not Classified
618Medical Assistant
639Orthotics/Prosthetics Fitter
647Perfusionist
648Podiatric Assistant
666Respiratory Therapy Technician
Therapists and Counselors 402Art/Recreation Therapist
405Massage Therapist
410Occupational Therapist
430Physical Therapist
450Rehabilitation Therapist
621Counselor, Mental Health
651Professional Counselor
652Sex Offender Counselor
653Pastoral Counselor
654Professional Counselor, Alcohol
657Professional Counselor, Family/Marriage
658Other Rehabilitative, Respiratory, and Restorative Service Occupation
660Professional Counselor, Substance Abuse
661Marriage and Family Therapist
662Art Therapist
663Respiratory Therapist
664Recreation Therapist
665Dance Therapist
667Music Therapist
668Other Behavioral Health Occupation - Not Classified
Other200Dietitian
210Nutritionist
211Other Dietitian/Nutritionist - Not Classified
400Audiologist
460Speech/Language Pathologist
600Acupuncturist
601Athletic Trainer
615Homeopath
624Midwife, Lay (Non-Nurse)
627Naturopath
699Other Health Care Practitioner - Not Classified

Note: * Practitioners that do not have a Field of Licensure listed are not included.


Privacy Act - the law that establishes safeguards for the protection of Federal systems of records the Government collects and keeps on individual persons.

Professional review action - an action or recommendation of a health care entity:

(Video) NPDB Guidebook: National Association Medical Staff Services

  • (1) taken in the course of professional review activity;
  • (2) based on the professional competence or professional conduct of an individual physician, dentist, or other health care practitioner which affects or could affect adversely the health or welfare of a patient or patients; and
  • (3) which adversely affects or may adversely affect the clinical privileges of the physician, dentist, or other health care practitioner.

The term professional review action excludes actions which are primarily based on:

  • (a) the physician's, dentist's, or other health care practitioner's association, or lack of association, with a professional society or association;
  • (b) the physician's, dentist's, or other health care practitioner's fees or the physician's, dentist's, or other health care practitioner's advertising or engaging in other competitive acts intended to solicit or retain business;
  • (c) the physician's, dentist's, or other health care practitioner's participation in prepaid group health plans, salaried employment, or any other manner of delivering health services whether on a fee-for-service or other basis;
  • (d) a physician's, dentist's, or other health care practitioner's association with, supervision of, delegation of authority to, support for, training of, or participation in a private group practice with, a member or members of a particular class of health care practitioner or professional; or
  • (e) any other matter that does not relate to the professional competence or professional conduct of a physician, dentist, or other health care practitioner.

Professional review activity - an activity of a health care entity with respect to an individual physician, dentist, or other health care practitioner:

  • (1) to determine whether the physician, dentist, or other health care practitioner may have clinical privileges with respect to, or membership in, the entity;
  • (2) to determine the scope or conditions of such privileges or membership; or
  • (3) to change or modify such privileges or membership.

Professional society - an association of physicians or dentists that follows a formal peer review process for the purpose of furthering quality health care.

Query - a request for information submitted to the NPDB by an eligible entity or authorized agent.

Report - record of a medical malpractice payment or adverse action submitted to the NPDB by an eligible entity.

Secretary - the Secretary of Health and Human Services.

Section 1128E of the Social Security Act - enacted as Section 221(a) of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191. One of the three enabling statutes underlying the NPDB. Reports collected under Section 1128E are not included in this Data Analysis Tool.

Section 1921 of the Social Security Act - enacted as Section 5 of the Medicare and Medicaid Patient and Program Protection Act of 1987, Public Law 100-93. One of the three enabling statutes underlying the NPDB.

Self-query - a subject's request for information contained in the NPDB about himself or herself.

(Video) Orientation Session for State Licensing Board Users

State - the 50 States, the District of Columbia, Puerto Rico, the Armed Forces, and other territories. In this tool, state is defined as the reporting entity state for state licensure actions. For clinical privileges actions in Federal agencies, state is defined as the practitioner's work state. For non-Federal clinical privileges actions, state is defined as the reporting entity state. If work state is not available, then the practitioner's home state is used. If both work state and home state are unavailable, then the practitioner's license state is used. For all other reports, including medical malpractice payment reports, state is defined as the practitioner's work state. If work state is not available, then the practitioner's home state is used. If both work state and home state are unavailable, then the practitioner's license state is used.

State Licensing Board - a generic term used to refer to State medical and dental boards, as well as those bodies responsible for licensing, certifying, or otherwise authorizing physicians, dentists, or other health care practitioners to provide health care services. See also Board of Medical Examiners, State Licensing or Certification Authority, and State Medical or Dental Board.

State Licensing or Certification Agency - defined in NPDB regulations as “includes, but is not limited to, any authority of a state (or of a political subdivision thereof) responsible for the licensing or certification of health care practitioners (or any peer review organization or private accreditation entity reviewing the services provided by health care practitioners), health care entities, providers, or suppliers. Examples of such state agencies include Departments of Professional Regulation, Health, Social Services (including State Survey and Certification and Medicaid Single State agencies), Commerce, and Insurance.”

State Licensing or Certification Authority - a State Government body that: licenses, certifies, registers, or otherwise authorizes health care practitioners, entities, providers, or suppliers to provide health care services; and/or certifies physicians, dentists, other health care practitioners, entities, providers, or suppliers for participation in a Federal or State health care program. Examples of such State agencies include departments of professional regulation, health, social services (including State survey and certification and Medicaid single State agencies), commerce, and insurance.

State Medical or Dental Board - a board of medical examiners.

Title IV - Title IV of the Health Care Quality Improvement Act of 1986, Public Law 99-660. One of the three enabling statutes underlying the NPDB.

Unique Practitioner - one practitioner can be counted in multiple types and in multiple states, which would cause a summation of either category to be greater than the actual unique practitioner count.

Year - Adverse Action Reports use the year the action was taken and Medical Malpractice Payment Reports use the year of the payment.

FAQs

What is a NPDB self-query report? ›

The Self-Query service searches the NPDB to see if the information an individual or entity provides in a Self-Query request matches any report information stored in the NPDB.

What is the meaning of NPDB? ›

The National Practitioner Data Bank (NPDB) is a web-based repository of reports containing information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers.

How do I get a NPDB report? ›

To Retrieve a Historical Report Summary

Sign into the NPDB. On the Select an Option page, select Historical Search. If Historical Search is not an option, select Report, then select Historical Search.

Who uses NPDB? ›

The NPDB is used only for the NPDB's mission of protecting the public and providing quality health care. However, you may request information from the NPDB's public use file in a form that does not identify any particular organization or practitioner (see Access to Statistical Data below).

Who can see NPDB reports? ›

Who can view my report? The general public does not have access to NPDB information and cannot view your report. However, registered health care organizations that meet federal requirements may query the NPDB to receive report information on health care professionals.

How do I run a NPDB query? ›

To Submit a Query
  1. Sign into the NPDB.
  2. On the Select an Option page, select Query. ...
  3. On the Subject Type page, choose Individual Subject or Organization Subject to query. ...
  4. Choose Select a Subject if the subject is currently in the subject database. ...
  5. If you select Use a Blank Query Form, complete the Query Input form.

What is the purpose of the NPDB and why was it created? ›

The National Practitioner Data Bank (NPDB) was established by the Health Care Quality Improvement Act of 1986 (HCQIA) to protect the public by restricting the ability of practitioners to move from State to State or hospital to hospital without disclosing medical malpractice payments or adverse action histories at the ...

How often should the NPDB be checked? ›

Every 2 years (biennially) on all physicians, dentists, and other health care practitioners who are on the medical staff (courtesy or otherwise) or who hold clinical privileges.

How much is a NPDB self query? ›

A $3.00 fee is charged per digitally certified Self-Query.

Is NPDB open to the public? ›

The NPDB is prohibited by law from disclosing information to the general public. However, there is statistical data available to the public that does not identify individuals.

What happens when you are reported to the NPDB? ›

These reports can result in denial of credentialing, loss or limitation of privileges, exclusion from participation in health plans, loss or limitation of license, and increases in professional liability insurance premiums or even exclusion from coverage, says Smalls.

Are NPDB reports confidential? ›

Information reported to the NPDB is considered confidential and will not be disclosed except as specified in the NPDB statutes (Title IV, Section 1921, and Section 1128E) and implementing regulations (45 CFR Part 60).

How long does a self query take from NPDB? ›

Once a completed Self-Query request is received by the NPDB, it may take up to one business day to process.

How long do reports Stay on NPDB? ›

Reports in the NPDB do not expire. Information reported to the NPDB is maintained permanently, unless it is corrected or voided from the NPDB by the reporting entity or by the NPDB as a result of the Dispute Resolution process.

What are the limitations of the NPDB? ›

A limitation of NPDB information is that malpractice payments recorded in the NPDB do not necessarily constitute a comprehensive and definitive reflection of actual health care incompetence.

Is personal information listed on the NPDB? ›

Personal information is only provided to registered organizations with Federal authority to query the NPDB. Information is not shared with any other non-registered third-party organizations with the exception of plaintiffs' attorneys.

Can a NPDB report be removed? ›

Can I have my report changed or removed? The NPDB is prohibited by law from changing or removing a report. Organizations that submit reports to the NPDB are responsible for the accuracy of the information they submit, and are required to certify that the report is accurate.

What should the nurse understand about being reported to the NPDB? ›

Nurses should know the licensure discipline will be reported, understand that the information reported to the NPDB is permanently maintained, and be advised on how to obtain copies of the reports and respond to inaccuracies in them.

What steps can be taken to avoid an NPDB report? ›

Another way to avoid a NPDB report is to avoid a lawsuit. Talking with patients orally when they are upset or seeking reparation, and reaching an agreement to refund payment or cover expenses, can all help a physician avoid a NPDB report (as long as there is no payment made by a carrier).

Why can't NPDB verify identity? ›

You may not be able to use online verification for the following reasons: You did not enter a SSN on your form. You have a limited credit history. You are the victim of identity theft.

Are nurses in the NPDB? ›

The most commonly reported profession to the NPDB is actually nurses, not physicians. Health Centers may query on all types of health care practitioners.

What is not reportable to the NPDB? ›

Adverse clinical privileges actions should not be reported to the NPDB unless they adversely affect the practitioner's clinical privileges for a period longer than 30 days. Matters not related to the professional competence or professional conduct of a practitioner should not be reported to the NPDB.

What is one type of information that must be reported to the NPDB? ›

Medical malpractice payments. Federal and state licensure and certification actions. Adverse clinical privileges actions. Adverse professional society membership actions.

What is NPDB continuous query? ›

24 hours a day, 365 days a year, Continuous Query keeps you informed about your enrolled practitioners. You will receive email notifications within 24 hours of a report received by the NPDB. Continuous Query is only for querying on practitioners, not health care organizations.

How long does it take to get a NPDB report? ›

Once the electronic results of your Self-Query are available, the paper version of your results is sent via US Mail. Allow 10 business days for US Mail delivery to your address. Note: The NPDB cannot expedite the shipping of your Self-Query results.

How much does it cost to query the NPDB? ›

There is no cost to register with the NPDB. There is no cost for reporting to the NPDB. However, there is a fee to query the NPDB, which is $2.50 per query.

How long does information stay in the National Practitioner Data Bank? ›

Reports in the NPDB do not expire. Information reported to the NPDB is maintained permanently, unless it is corrected or voided from the NPDB by the reporting entity or by the NPDB as a result of the Dispute Resolution process.

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